A WHO nutrient profile model: the European perspective. J. Breda Programme Manager Nut., PA & Obesity WHO Regional Office for Europe

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1 A WHO nutrient profile model: the European perspective J. Breda Programme Manager Nut., PA & Obesity WHO Regional Office for Europe Platform for Action on Diet, Physical Activity and Health Brussels, 24 th November 2014

2 Overview Brief recap of context and mandate for WHO s work on nutrient profiling Previous work by WHO in this area Specific objectives of developing a WHO Nutrient Profile Model About the model Next steps

Nutrient profiling is a tool to categorise foods, not diets, but can be used via policy to improve the overall nutritional

3 NP is the science of classifying or ranking foods according to their nutritional composition for reasons related to preventing disease and promoting health. Nutrient profiling is a tool to categorise foods, not diets, but can be used via policy to improve the overall nutritional quality of diets It has been recognized by WHO as a useful tool for a variety of applications The WHO Set of Recommendations on Food and Non-Alcoholic Beverages to Children highlights nutrient profiling as one approach to categorising foods

The Vienna Declaration on Nutrition and NCDs includes a commitment to

States committed to work with WHO to develop and adopt regional

4 The Vienna Declaration on Nutrition and NCDs includes a commitment to take decisive action to reduce food marketing pressure to children Member States also called for common tools, such as nutrient profile models In the European Food and Nutrition Action Plan Member States committed to work with WHO to develop and adopt regional approaches to nutrient profiling for the purposes of restricting the marketing to children

addition to a catalogue of existing models The European Network on Reducing Marketing Pressure on Children, led by the

5 Previous work by WHO in this area WHO has been working with Member States in the development of nutrient profile models since 2009 A guiding principles and framework manual (in press) has been developed and field-tested in six different countries, in addition to a catalogue of existing models The European Network on Reducing Marketing Pressure on Children, led by the Norwegian Directorate for Health and facilitated by the WHO Regional Office for Europe, has conducted some work related to nutrient profiling

Previous work by WHO Status of policies on food marketing No action reported Partially or fully implemented Comprehensive policy Countries (N) 20 33 0 A 2013 report by the WHO Europe found that,

6 Previous work by WHO Status of policies on food marketing No action reported Partially or fully implemented Comprehensive policy Countries (N) A 2013 report by the WHO Europe found that, despite progress, few countries have fully implemented restrictions on the marketing of foods to children No countries have taken a fully comprehensive approach Many countries report difficulty in overcoming the challenge of classifying foods - may result from the lack of a nutrient profile model Only Denmark, Ireland, Norway and the UK have used a nutrient profile model in connection with marketing restrictions.

7 Objectives of developing a regional model Respond to requests for technical support from countries To draw on lessons learned by those countries that have already developed nutrient profile models for the purpose of restricting the marketing of foods to children Design a model that is easy for countries to incorporate into policy at the national level (allowing for minor adaptation if necessary) Provide a common solution to a common challenge, with regional and global impact

8 Process of developing the model Three European models were discussed at an expert meeting: UK, Norwegian and Danish models These are the only three models that are currently in use in Europe for restricting marketing to children and have either been developed by government or endorsed by government (in the case of the Danish model). Each of the models was considered relatively strict and categorized foods similarly (i.e. most of the same foods would/would not be permitted) Ultimately it was decided to base the European nutrient profile model on the Norwegian and Danish models Category-specific models are easier to adapt or modify than models based on scoring, which is an important consideration for a regional model that countries will be looking to use nationally.

9 Process of developing the model Countries were actively involved in the development of the European model Face-to-face meetings with countries Pilot testing in 15 countries looking at frequently-marketed and commonly-consumed food products Feedback and modification Anticipated publication in early 2015

10 About the model Model consists of 19 food categories (incl. sub-categories) Majority taken from Norwegian model, some from Danish (where not included in Norwegian), and some additional categories following consultation with countries Descriptions of the food products included/not included within the food categories were taken from both models and supplemented with further examples Guidance for food companies also provided by customs tariff codes

11 About the model Food Product Categories 1. Chocolate and sugar confectionary, energy bars, sweet toppings and desserts 2. Savory snacks 3. Beverages i. Juices ii. Milk drinks iii. Other beverages 4. Edible ices 5. Breakfast cereals 6. Cakes, sweet biscuits and pastries, other sweet baker s wares and other such dry mixes 7. Yoghurts, sour milk, cream and other similar foods 8. Ready made, convenience foods and composite dishes 9. Cheese 10.Butter and other fats oils 11.Bread, bread products and crisp breads 12.Fresh or dried pasta, unprocessed rice and grains 13.Fresh and frozen meat, poultry, fish and similar 14.Processed meat, poultry, fish and similar 15.Fresh and frozen fruit and vegetables 16.Processed fruit and vegetables 17.Sauces and dressings

12 About the model The nutrients covered by the model are total fat, saturated fat, total sugars, added sugars, and salt; products containing trans-fat are prohibited Energy (kcal) is a criterion for ready meals, convenience foods and composite dishes; added sweeteners is a criterion for some beverages Thresholds taken from Norwegian model, unless the Danish model was stricter Where missing from both, salt thresholds were taken from the Finnish Decree on Food Package Markings Some thresholds made stricter following feedback from countries

13 How does the model work? Identify which food category the products falls under. In some case this will be very clear according to the food category name (e.g. breakfast cereals; yoghurts). In other cases, it may be necessary to refer to the included in category or not included in category columns, and/or check the customs tariff code number. The nutritional content of the food product must then be cross-checked against the thresholds. A food product must not exceed (on a per 100g/ml basis) any of the relevant thresholds for that category. For example, in the case of breakfast cereals, a product must not exceed the criteria for total fat, total sugars or salt. The food products should, where possible, be assessed as sold or as reconstituted (if necessary) according to the manufacturer s instructions. If the marketing is for a restaurant meal, including a quick-service or takeaway meal of two or more menu items, then all items should meet the nutrient criteria.

14 Feedback from countries Overwhelmingly positive Categories considered to be appropriate and easy to use Thresholds appropriately strict, with only minor modifications recommended Consistent with food-based dietary guidelines and WHO recommendations Results of pilot-testing demonstrate some variation in the marketing environment across countries: Nutritional quality of products frequently marketed significantly worse in some countries

15 Next steps The model will be finalised in the next few weeks and published in early 2015 Continued collaboration with colleagues in headquarters and other WHO regional offices to build on our experience Continued support to countries across the region to develop policies to restrict food marketing to children, with the nutrient profile model as a key tool to underpin policy development

No. of products >=3.5 Health Star Rating ineligible to display health claim (%)

No. of products >=3.5 Health Star Rating ineligible to display health claim (%) Table S1: Agreement between the number of products scoring >=3.5 stars using the Health Star Rating and the proportion of products eligible to display a health claim using the Nutrient Profiling Scoring